Provider Demographics
NPI:1912908229
Name:MELCHIONNA, EMILIO M (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:M
Last Name:MELCHIONNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CAREW ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2485
Mailing Address - Country:US
Mailing Address - Phone:413-781-5050
Mailing Address - Fax:413-781-2510
Practice Address - Street 1:300 CAREW ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2485
Practice Address - Country:US
Practice Address - Phone:413-781-5050
Practice Address - Fax:413-781-2510
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA758822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3126218Medicaid
MAJ14719Medicare ID - Type Unspecified
MA3126218Medicaid